Dank u hartelijk Jaap. Ik ben in Suriname geboren. Your submission took my breath away when you almost to 100% accuracy described the frustration clients experience. I could not in this life time seen the sentiments echoed so strongly from someone that feels the heartbeat, soul and spirit of what happens at the grassroots and layers in between of which CCMs have simply adapted a "SO WHAT I'M GOD" attitude, a culture of reckless irresponsibility that may have needlessly make millions loose their lives. This I dare to coin as "an entrenched culture of impunity" among CCMs. Jaap I could see diplomacy written all over it but wonder whether the GF has really taken us very serious or was it that we just wasted our precious consulting hours with reading and responding? "The present system of planning for the three killer diseases does not provide room for this, because the emphasis is on the technical frameworks and technical language is spoken that is not understood by many potential participants in the health plight, nor is it effectively reaching the RSRV. It is high time that many excellent and low cost proposals can be taken up in the new GF grants. This is in my view an approach that strengthens demand and increases CBO and FBO participation". I can't more agree. The language of bureaucrats differs vastly from realities on the ground. What no one touched on during all these sessions is that for us to make a drastic dent in the prevalency of HIV/AIDS, TB and Malaria...we need to address the issues of poverty and illiteracy among our communties. The Managing Director of the Global Fund and I had a discussion duirng the HDP Forum in Nairobi the week of Oct 18, 2007 and I told him that in order to address these three diseases we must address poverty...these are also diseases associated with poverty. Poverty cannot be alleviated if we don't address illiteracy. These are also conditions associated with functional illiteracy. In as much as you medicate our people affected and infected with these diseases, they experience serious challenges with drug regimen adherence, skip dosages due to lack of money, sell the drugs, or simply don't want to take the drug because of the side effects. As a healthcare professional, I emphasize that treating patients with TB and leaving them in a highly congested environment, slum or high population density area makes them prone to reinfection and also transmission of the infections to others whose resistance is already compromised due to poor nutrition. We must physically remove our sick people from the environment that is conducive to disease transmission through coughs. Most of the patients that live in very crammed up small shacks continue infecting each other and then can die of the disease. Worst yet, most of them develop the ugliest forms of drug resistance which is a viurtual death sentence handed down for Africa and other parts. The science of preventative health is one of cause and effect which is not within the framework of African Traditional Knowledge Systems. Science deals with cause and effect and is mechanical. The traditional worldview is spirit orignated which explains that the concept of preventative health is construct introduced by Western Medicine and imposed upon the traditional worldview. This has gained foothold in pockets; hece we see transformation in such societies. The traditional worldview doesn't provide for the conceptualization and hence there is a marked disconnect between the perception of illness and preventative health and wellness. This has not been factored in by the GF. These are core issues that must be addressed now. The success of any GF program hinges on the successful integration of worldview transformation models in all patient education learning models. This is not done anywhere in the world. Will we achieve the MDG for TB, Malaria and HIV/AIDS to cut this in half by 2015? I humbly apologize and don't want to give in into defeat or be pessimistic. Even though extremely ambitious, this I'm afraid may not be achieved unless the GF puts a human face to the current prevaling technical frameworks and technical language. Please allow me to thank all contributors to this forum. You have enriched my life in more than a million ways. Because of my disability/injuries to 7 fingers distal phalangeals it takes me hours and hours to type each response with much pain. I hope I have made a small difference to all those that love to read what I write. Fenna E. Bacchus, Global Expert "The Worldview Transformation Paradigm" + 1407 484 0292 fennabacchus@cfl.rr.com